Adherence of long-term breast cancer survivors to follow-up care guidelines: a study based on real-world data from the SURBCAN cohort

Abstract

Purpose To identify adherence to follow-up recommendations in long-term breast cancer survivors (LTBCS) of the SURBCAN cohort and to identify its determinants, using real-world data. Methods We conducted a retrospective study using electronic health records from 2012 to 2016 of women diagnosed with incident breast cancer in Spain between 2000 and 2006 and surviving at least 5 years. Adherence to basic follow-up recommendations, adherence according to risk of recurrence, and overall adherence were calculated based on attendance at medical appointments and imaging surveillance, by year of survivorship. Logistic regression models were fitted to depict the association between adherence and its determinants. Results A total of 2079 LTBCS were followed up for a median of 4.97 years. Of them, 23.6% had survived ≥ 10 years at baseline. We estimated that 79.5% of LTBCS were overall adherent to at least one visit and one imaging test. Adherence to recommendations decreased over time and no differences were found according to recurrence risk. Determinants of better overall adherence were diagnosis in middle age (50–69 years old), living in a more-deprived area, having fewer years of survival, receiving primary treatment, and being alive at the end of follow-up. Conclusion We identified women apparently not complying with surveillance visits and tests. Special attention should be paid to the youngest and eldest women at diagnosis and to those with longer survival.

Rethinking breast cancer follow-up based on individual risk and recurrence management

“…Several studies are promoted on the development of "patient-centered medical homes" whose philosophy is based on primary care patient-centered, complete, teambased, coordinated, accessible and focused on quality and safety [119]. Different players should be involved and considered, including in first place general practitioners (GPs), psychologists and specialists in oncological field (i.e., medical and radiation oncologists, nurse, case manager) [120,121]. The approach to the patient should be multidimensional to take into consideration not only the survivor as a patient within programs aimed at the early diagnosis of disease recurrence but above the person, as entirety, and his family network.…”

Determining the Appropriateness and Acceptability of a Reduced Postradiotherapy Surveillance Practice in Breast Cancer Patients: Results of a Longitudinal Observational Study

“…In breast cancer patients, Ouyang et al [24] reported a loss to follow-up rate of 12.9% (198/1536 patients) in the frst year and 26.8% (411/1536 patients) in the ffth year after surgery. Santiá et al [9] reported a similar loss to follow-up rate of 19% (37/194 patients) after the 6th year, which increased to 30% (97/326 patients) after the 16th year. Possible countermeasures include the use of reminder intervention to improve adherence to appointments, such as postradiotherapy follow-up [9,[22][23][24][25].…”

“…Santiá et al [9] reported a similar loss to follow-up rate of 19% (37/194 patients) after the 6th year, which increased to 30% (97/326 patients) after the 16th year. Possible countermeasures include the use of reminder intervention to improve adherence to appointments, such as postradiotherapy follow-up [9,[22][23][24][25]. In a cross-sectional study, Bruns et al [25] demonstrated that reminder intervention in breast cancer patients resulted in signifcantly higher rates of attendance at postradiotherapy follow-up; specifcally, he reported an absolute decrease in nonattendance from about 24% to 18% after written (postal) reminders and from about 24% to 9% after telephone reminders.…”

“…Due to the increasing number of patients who have become long-term breast cancer survivors, attention has also been focused on the late efects of radiotherapy [8,9]. Participation in postradiotherapy follow-up helps patients maintain their quality of life by providing information about possible late toxicities and, if necessary, treating late radio-oncological toxicities in a timely manner to avoid potential adverse health efects [10].…”